Activekidz and Adult Therapy Services

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5588 Issued in GA

Legal business name

ACTIVEKIDZ AND ADULT THERAPY SERVICES

Practice address

1071 Thomas Ave
Watkinsville, GA 30677-6073

Phone

(770) 207-6390

Fax

(678) 374-4855

NPI assigned

Aug 5, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Susan Cook, PT

Title

Owner

Phone

(770) 207-6390

Specialties & licenses 3

Addresses

Other identifiers 3

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1249430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714003200000",
    "number": "1962633131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1431 CAPITAL AVE STE 123",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "306771883",
            "telephone_number": "706-338-8058",
            "fax_number": "678-374-4855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1071 THOMAS AVE",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "306776073",
            "telephone_number": "770-207-6390",
            "fax_number": "678-374-4855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVEKIDZ AND ADULT THERAPY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-05",
        "last_updated": "2024-04-25",
        "certification_date": "2024-04-25",
        "status": "A",
        "authorized_official_last_name": "COOK",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-207-6390",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "5588",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "GA",
            "license": "3287",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "5359",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003130033A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000875102B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000964169E",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• A. Shayne Abelkop PH.D. PC
• Adrian Shayne Abelkop, PH.D.
• Abigail S. Holbrook, MSW, LCSW, LLC
• Howard Teasley Abney, M.D.
• Achilles Foot & Ankle Specialist
• Ryan Adams
• Adfc-Watkinsville PC
• Advanced Gynecology PC
• Agape Hospice Care of Clarke County, LLC
• Kathryn Agel

• All providers in Watkinsville, GA
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.